3
Codependence Theories Various concepts and formulations Lack of compelling empirical validation of any theory Controversies – Disease, syndrome, or assortment of traits Whether addictions need to be involved Blaming women a criticism of some theories Need for objective exploration of constructs

4
Observations by Persons in Recovery Some in remission (sober) were abstinent but had not achieved serenity Unresolved issues perceived to be inducing current distress Medicating unresolved issues with antianxiety and depression prescriptions not a solution Current distress seemed to pose a relapse risk Current distress reduced quality of life

10
Jolt Scale 7 Items Content concepts Clearly remember first use Get a memorable “jolt” from use Nothing else gives a feeling like use Feel different after use Nothing else is like feeling with use Internal consistency reliability =.665

11
Avoidance Coping Scale 6 Items Content concepts Use to forget troubles Use to alleviate depression or anxiety Use to improve mood Use to feel more confident Use to forget worries Internal consistency reliability =.665

12
PTSD Scale – Based on DSM-5 Criterion A: Type of traumatic event: 4 items Criterion B: Intrusion symptoms : 5 items Criterion C: Avoidance of stimuli/reminders: 2 items Criterion D: Negative cognitions/mood : 7 items Criterion E: Arousal and reactivity : 6 items Total number of items 24 Produces a scale based on the total number of positive criteria; Internal Consistency =.892 Algorithm produces a diagnosis based on Criteria B through E all being positive on one or more items

14
Sample DARNU Items I often feel discontented. I often think I should be feeling better about myself. I tend to be a nervous person. I am an anxious person. I usually have less fun than most people. I (don’t) feel very positive about myself. I (don’t) have a strong sense of self-worth. I am (not) confortable with who I am most of the time.

15
Comments about Distress Scale More complex and distinct from depression or anxiety Distinct from the MMPI Demoralization Scale, which has more hopelessness with depressive content The Distress Scale seems to reflect an active disquiet and discomfort

16
The UNCOPE as SUD Scale U – Have you spent more time drinking/using than intended? (Unintended Use) N – Have you ever neglected usual responsibilities because of using? C – Have you ever wanted to cut down on drinking/using? O – Has anyone objected to your drinking/use? P – Have you found yourself thinking a lot about drinking/use? (Preoccupied) E – Have you ever used to relieve emotional distress, such as sadness, anger, or boredom?

17
UNCOPE: A Brief Free Screen for Substance Use Disorders Six items used in screening adults and adolescents for any substance use disorder Free – from Evince Clinical Assessments [research tab at www.evinceassessment.com] Two or more positive responses indicate risk for a severe substance use disorder Sensitivity for severe = 90% to 95% Specificity for severe = 90% to 95%

19
Co-dependence Summary Current distress (DARNU) is modestly related to negative family of origin issues, indications of substance dependence, and dysfunctional relationships Family of Origin problems and dysfunctional relationships are not significantly related No syndrome, BUT family of origin and dysfunctional relationships may be related to current problems without manifesting a “syndrome”

20
Pavillon Study of Trauma, Distress, and Craving Evaluation of potential problems and relapse risks for those entering treatment Distress measure, PTSD symptom count, and validated craving measures for alcohol and drugs Explore the possibility of identifying level of distress and trauma relative to craving

22
Correlation Summary Origin and Helper modestly related to DARNU DARNU and PTSD close to identical scales – DARNU highly predictive of PTSD JOLT has the highest average correlations with all the other scales – suggests that “reactivity” to substances is important construct – also a risk factor on Dimension 5 of the ASAM Criteria

24
Scales of Interest JOLT, PTSD, and DARNU correlate highest with craving Multivariate regression yields a moderate association (R =.519) – because the scales correlate with each other they don’t tend to add unique contribution to prediction Multivariate regression for PTSD: R =.796 not much more than DARNU alone

27
Questions to be Addressed Can a written instrument with either the DARNU and/or PTSD scales identify PTSD in routine clinical practice with questions scored from 1 (strongly disagree) to 4 (strongly agree)? What do those with high DARNU but no PTSD look like? Does the level of DARNU have a relationship to the severity or prognosis for those with PTSD diagnosis? Is prognosis predictable from these scales?